12090010 CITY OF CUPERTIN10 BUILDING,PE'RMIT
'BUILDING ADDRESS: 20370 TOWN:CENTER LN. CONTRACTOR;AIR QUALITY HEATING!& PERMIT NO: 12090010
_ AIR
OWN'ER1S NAME: EUND'VIILCURERT[NO;LLC 720 NORTHRUP ST DATE ,ISSUED:09/04/20"l2
OWNER'S PHONE': 40.'84463'1151 SAN JOSE,.,CA-,95126 PHONE:NO:(408)293=7,138
LICENSED CONTRA DECLARATION', f7 I'! F
BUILDING PERMIT INFO- BLDG ELECT. PLUMB
License Class Lic.# IV, u
MECH RESIDENTIAL� COMMERCIAL
:Contractor Date
I hereby affirm,thaf I,am licensed p der the provisions( Chapter 9 JOB DESCRIPTION: INSTALLATIO_N OF'11SENTRAL:A/C UNITS,FOR OFF
,(commencing with Section_ 7000 .of Division3'of-ttie Business&�.P,rofessions HOURS
( - g ). USE
Code?and,that my license is;in full force"and.effeets
I hereby°affirm,under penalty of perju_ry'o-nelofthe4611owing°,two declarations:
,lThave and:Will maintain a,certificate:ofconsent;toiself-insiffe•forWoiker,'s
Com"pensation,'as providcd.forby'S'ectibn 3760tofihe Labor Code;for;the
' 7performancerof the,work forwhich ih'is permitais issued:
I'have an&wilI maintain Worker's Compensation insurance,,�as provided for by
5ecti'on,3700 ofthe�LaborCode;for the perforinance?of the work.forwhich this. Sq.RLEIoorArea: Valuation:$25.000
perm[i`s issued.
APPLICANT CERTIFICATION; APN Number.36940059:""20370: Occupancy Type:
1certify4hat I.have read tfii`s"application andatate-that,tfie above informatiomis
correct.1'agree;to-cot-holy,.with alI�city.=and county'ordinancestand state laws°relating:
fo',buildi'ng'constructi'on,and herebyauthorize:representatives ofthisticityto enter
upon the above mentioned property for inspection,purposes. (We)'agrce to save, PERMIT EXPIRES IF WORK,IS NOT'STARTED
:indemnify_and keep`fiarmless the City ofCup ertmo^agamsCliabihties,judgments;
,costs and expenses which'may accrue against said.Cityin consequence of the WITH,I_N 180 DAYS'OF PERMIT ISSUANCE OR
granting of this permit Additionally„the applicant understands and mill comply 180 DAYS LAST CALLED INSPECTION.
with all -point regulations-per'the'�GupertinoNbriiapal Cod;,Section
Issue Date:.
Signatures. - _ Date `
❑ :OWNER'BUILDER DECLARATION
RE-ROOFS': .
hereby`aflirm;that l'am exempt feorn the Cbnteactor;,sFLicens`e Law:for one;of All roofs shall be inspec'd;priorfo any roofing.material being;instaked. [f°ajoof is
the followin ;two reasons:
g,- installed.without fist+obtairiing�an:inspection,.[agree to�remoye all ne_w,materials for
1,as'owner,of,the,property„or.my:mployees with+wages.as their sole compensation, inspection:
will'dothe,wor, and the structure;is not_imended orofferedi
CITY OF CUPT RTI.NO
FEE ESTIMATOR:— BUIMING DIVISION
3y ADDRESS: 20370 Town Center#211 DATE. 0:9/04/20.12 REVIEWED:BY: Sean
APN: BP#: *VALUATION: $25;OQ0
to V 00
*PERMITrTYPE: Mechanical Permit I PLAN°CHECK TYPE: Alteration/Addition./ Repair
'PRIMARY PENTAIVMTION
USE: Commercial.Building PERMIT TYPE: FURN/AC
WORK :Installation of 2' centra l:A/.0 units'for off hours use.
SCOPE
APPLIANCE././EQUIP TYPE FEE ID QTY UNITS BP FEES
Air-Handli'n'g (>1OKcfm) _ f'tl/rk 2 # $266
TOTALS; $266.00low
Mech.,Plan Check0:0 ,:hrs $0.00 �'(r rr7i. Pl(rm Check Elec. /Flan Check
Mech.Permit Fee:,LMPERMIP nlumh, l'o-M l'Fec:
LOther'Mech-Insp. 0.0 ,hrs $45'.00', U!/Fer�F'lIarnb/r�yp. El L__ CJI/;�Y/Jlec..Ihsp:
lash.'Fe_er, )�hirrili.:li7sjz ('er: Etec.frV.:I ee_
NOTE:ThisAestimate,does no"t include fees due,to other Departments(i.e.Planning,Public Works,Fire„Sanitary-Sewer District,,School
District;'etc): These”ees are:based.ou the` relimina, iin ormation available and,are on l -:an estimate. Coittact,the De t_ oraddn'[ino.
FEE.ITEMS:,(ree Resolution ll1.053 Ef: 711,11,1) FEE 'QTY%FEEMISGITEMS.
IN n Chc cic.F'c t
Szt J ll: de
PME;PIan'Check:: $0.00
Pc,rinit Fee:
$qpp j. I%isp Fe.0
PME Uriit Feel $266:00
PME,Permit Fee;: $45:00;
Gonstrxtction.Ta_v.
Adf nistrative,f6b: IADMITJ $42:00
Work Without Permit? Yes .(F) No $Q:00
�1�<lvcbic>ecl'1'lzrrnaing Fees:
Travel Documentation Fee: ITRA VDOC $4.5..Q0
St"r`on Motion:Fee: 1BSEISMICo $,5:25' Selectan Adriiinistrative Item
Bld'g:Stds Commission Fee:, IBCBSC
SUBTOTALS $4042.5 $0.00 ' TOTAI,FEE• $404.25
Revised; 07/01/2012